Hongmin Zhang

Melatonin improved rat cardiac mitochondria and survival rate in septic heart injury

The pathogenesis of septic myocardial depression is complicated. Mitochondrial dysfunction has been suggested to be one of the main reasons for the reduced cardiac function. As melatonin is an antioxidant with the potential to scavenge radicals in mitochondria, we therefore employed a sepsis model, that is, cecal ligation and double puncture (CLP) in rats, to study the melatonin effects on: (i), myocardial mitochondrial function; (ii), heart systolic function; and (iii), prognosis of septic rats. We demonstrate that melatonin treatment (30 mg/kg, 3, 6, 12, 18, 24 hr after CLP) (i) improved myocardial cytochrome c oxidase (CcOX) activity and blood lactate level, (ii) attenuated heart dysfunction with a higher left ventricular ejection fraction (EF), and (iii) promoted 48‐h survival of the rats compared to CLP animals with no melatonin treatment. In conclusion, our results show that rat myocardial mitochondrial CcOX activity was depressed during severe sepsis accompanied by myocardial depression characterized by the decline of EF. In septic rats, melatonin increased the CcOX activity, improved heart systolic function, and lowered mortality rate. The clinical use of melatonin in septic myocardial depression should be tested in the future.

Integrated Cardiopulmonary Sonography A Useful Tool for Assessment of Acute Pulmonary Edema in the Intensive Care Unit

Bedside sonography has become a popular method of assessment of critically ill patients with shock and dyspnea. This study evaluated the usefulness of integrated cardiopulmonary sonography for assessment of acute pulmonary edema.

Using Critical Care Chest Ultrasonic Examination in Emergency Consultation: A Pilot Study

The purpose of this study was to investigate the effects of critical care chest ultrasonic examination (CCUE) by intensivist on the diagnosis and treatment decisions in emergent consultation for patients who may have a problem-need transfer to an intensive care unit (ICU). A total of 130 patients who required emergent consultation in the ordinary wards were included in this study. Patients were randomly divided into conventional group (n = 63) and CCUE group (n = 67, added CCUE). The two groups showed no significant differences in general clinical information or final diagnosis (p > 0.05). The CCUE group had a shorter time to preliminary diagnosis, final diagnosis, treatment response and X-ray/computed tomography examination; a delay in ICU transfer and ICU stay days (3.9 ± 1.2 vs. 5.4 ± 1.9 d, p < 0.05) and a higher diagnostic accuracy than the conventional group (p < 0.001). In conclusion, CCUE could help early diagnosis and therapy for the patient who may need to transfer to the ICU and reduce the ICU stay for in-hospital patients in emergent consultation.

Central Venous Pressure Dropped Early is Associated with Organ Function and Prognosis in Septic Shock Patients: A Retrospective Observational Study.

Purpose: The aim of this study was to investigate changes in central venous pressure (CVP) of patients with septic shock over 7 days after intensive care unit admission and its effect on organ function and clinical prognosis. Methods: Baseline data, 7 days’ CVP, and laboratory data of 105 patients with septic shock were consecutively recorded. According to the value of mean CVP of 7 days, cases were divided into three groups: low (<8 mmHg), normal (8–12 mmHg), and high (>12 mmHg) CVP. According to whether CVP dropped to less than 8 mmHg, cases were divided into two groups. Results: There were significant differences in serum creatinine on day 5 and lactate on days 2 to 5 among low, normal, and high-CVP groups (P < 0.05). Total bilirubin on days 5 to 7, lactate on days 2 and 4 to 7, and SOFA (Sepsis-related Organ Failure Assessment) scores on days 5 and 7 in groups with CVP did not drop to less than 8 mmHg were higher than those in groups with CVP that dropped to less than 8 mmHg (P < 0.05). PO 2/FIO 2 on day 7 was lower in the group whose CVP did not drop to less than 8 mmHg (226 [184–278]) vs. 254 [214–306]; P = 0.048), whereas 28-day mortality was lower in the group whose CVP dropped to less than 8 mmHg (18.3% vs. 37.8%, P = 0.026). Conclusions: Central venous pressure was associated with kidney, liver, and lung function; SOFA scores; and lactate. Septic shock patients whose CVP dropped to less than 8 mmHg during 7 days had a higher survival rate.

Melatonin Balance the Autophagy and Apoptosis by Regulating UCP2 in the LPS-Induced Cardiomyopathy

To explore the mechanism of mitochondrial uncoupling protein 2 (UCP2) mediating the protective of melatonin when septic cardiomyopathy. UCP2 knocked out mice and cardiomyocytes were used to study the effect of melatonin in response to LPS. Indicators of myocardial and mitochondria injury including mitochondrial membrane potential, mitochondrial permeability transition pore, calcium loading, ROS, and ATP detection were assessed. In addition cell viability and apoptosis as well as autophagy-associated proteins were evaluated. Melatonin was able to protect heart function from LPS, which weakened in the UCP2-knockout mice. Consistently, genipin, a pharmacologic inhibitor of UCP2, augmented LPS-induced damage of AC16 cells. In contrast, melatonin upregulated UCP2 expression and protected the cells from the changes in morphology, mitochondrial membrane potential loss, mitochondrial Ca2+ overload, the opening of mitochondrial permeability transition pore, and subsequent increased ROS generation as well as ATP reduction. Mitophagy proteins (Beclin-1 and LC-3β) were increased while apoptosis-associated proteins (cytochrome C and caspase-3) were decreased when UCP2 was up-regulated. In conclusion, UCP2 may play a protecting role against LPS by regulating the balance between autophagy and apoptosis of cardiomyocytes, and by which mechanisms, it may contribute to homeostasis of cardiac function and cardiomyocytes activity. Melatonin may protect cardiomyocytes through modulating UCP2.

Bloodstream infection with carbapenem-resistant Klebsiella pneumoniae and multidrug-resistant Acinetobacter baumannii: a case report.

IN the presence of septic shock, every hour in delaying the administration of effective antibiotics is associated with a measurable increase in mortality. This is especially true for neutropenic patients with septic shock.1 As there is a higher incidence of involving multi-drug resistant pathogens for neutropenic patients, the decision on antibiotics regime remains a challenge for physicians.2 Immunosuppression and previous antibacterial use are factors that promote the spread of multi-drug resistant pathogens, and the possibility of co-existing multi-drug resistant pathogens should be suspected when treating patients with these risk factors who developed refractory shock. Here we present a case with neutropenic fever and refractory shock whose blood culture yielded multi-drug resistant Acinetobacter baumannii and carbapenem- resistant Klebsiella pneumoniae.

Left Ventricular Longitudinal Systolic Function in Septic Shock Patients with Normal Ejection Fraction: A Case-control Study

Background: Septic cardiomyopathy is a common finding in septic shock patients. The accepted definition of septic cardiomyopathy is often based on the left ventricular ejection fraction (LVEF). The aim of this study was to determine whether the left ventricular longitudinal systolic function was more sensitive than the LVEF in heart function appraisal of septic shock patients. Methods: This was a case-control study conducted at a 40-bed Intensive Care Unit (ICU) of Peking Union Medical College Hospital. Septic shock patients admitted to the ICU were consecutively enrolled in the study group from March 1, 2016 to September 1, 2016. The control group was selected from nonsepsis patients who were admitted to the ICU and were comparable to the study group. Transthoracic echocardiography was performed to obtain the LVEF measurement, mitral annular plane systolic excursion (MAPSE), tissue Doppler velocity measurement of mitral annulus (Sa), and tricuspid annular plane systolic excursion. Results: The study group consisted of 45 septic shock patients. Another 45 nonsepsis patients were selected as the control group. There was no difference in the LVEF between the two groups (64.6% vs. 67.2%, t = −1.426, P = 0.161). MAPSE in the study group was much lower than in the control group (1.2 cm vs. 1.5 cm, t = −4.945, P < 0.001). Sa in the study group was also lower than in the control group (10.2 cm/s vs. 11.8 cm/s, t = −2.796, P = 0.014). Conclusions: Compared to the LVEF, longitudinal systolic function might be more sensitive in the detection of cardiac depression in septic shock patients. In the heart function appraisal of septic shock patients with a normal ejection fraction, more attention should be given to longitudinal function parameters such as MAPSE and Sa.

Using anti-platelet therapy to prevent extracorporeal membrane oxygenator thrombosis without heparin resistance and with thrombocytopenia.

No abstract

Myocardial strain/stress changes identified by echocardiography may reveal early sepsis-induced myocardial dysfunction

Objective To perform early assessment of sepsis-induced myocardial dysfunction (SIMD) using strain/stress echocardiography. Methods A canine model of SIMD was established using intravenous injection of lipopolysaccharide (LPS, 2 mg/kg). Thirteen dogs were included, comprising an LPS-treated SIMD group (n = 7) and saline control group (n = 6). SIMD was assessed at various time-points using cardiac measurements including haemodynamics and echocardiography. Results Systolic and radial ventricular wall stress and circular ventricular wall stress (WSsc) were significantly lower in the sepsis group versus the control group at all time-points. Logistic regression analysis revealed an inverse correlation between stress rate of the front-posterior and bottom wall and left ventricle systolic wall strength. In contrast, a positive correlation was found between the mean velocity of circumferential fibre shortening (mVCF) or heart rate-adjusted mVCF (RVCF) and WSsc. Using regression equations, predicted values for mVCF and RVCF in animals with sepsis were significantly higher than measured values at 4- 5- and 6-h time-points. Conclusions These findings will further the understanding of pathophysiological alterations in SIMD at the early stage of sepsis, and suggest that strain rate may reflect the nature of myocardial contractility.

Relationship between inferior vena cava diameter ratio and central venous pressure

To explore the relationship between the shape of the inferior vena cava (IVC) lumen and central venous pressure (CVP).